构建结构方程模型分析药品零差价政策实施前后慢性病住院患者负担因子载荷变化

Analysis of the Changes of Burden Factor Loading for Chronic Disease Inpatients before and after the Implementation of Zero Price Policy by Establishing Structure Equation Model

目的:构建基层医疗机构慢性病住院患者负担的结构方程模型,分析药品零差价政策实施前后该类患者负担因子载荷变化。方法:在江苏省丹阳市内随机选取6家基层卫生院,收集药品零差价政策实施前后有关慢性病(高血压、糖尿病、支气管炎)的住院费用数据,以住院患者的药费、护理费、检查费、诊疗费为自变量,住院负担为潜变量,利用SPSS 19.0和AMOS 24.0软件进行模型构建。结果:药品零差价政策实施前后住院患者负担因子载荷变化明显;χ2=24.586,χ2/df=1.446,RMSEA=0.019,GFI=0.995,AGFI=0.989,CFI=0.988,NFI=0.963,模型拟合良好。药费的因子载荷上升较大,说明在药品零差价政策实施后,减轻了住院患者负担;检查费、诊疗费的因子载荷上升较明显,更能表征住院患者负担;护理费的因子载荷最低,在住院患者负担中影响最弱,政府应加强调控。结论:所建模型具有良好的信度,可以直观反映药品零差价政策实施前后住院患者负担因子载荷变化。

OBJECTIVE:To construct the structure equation model for the burden of chronic disease inpatients in primary hospital before and after the implementation of zero price policy,and analyze the changes of burden factor loading.METHODS:6primary hospitals were randomly selected in Danyang,Jiangsu province.The data of hospitalization expenses for chronic diseases(hypertension,diabetes,bronchitis)were collected before and after the implementation of zero price policy.Using drug cost,nursing fees,inspection fees and treatment fees as independent variables,hospitalization burden as latent variable,SPSS and AMOS24.0software were adopted to establish the model.RESULTS:The burden factor loading of inpatients changed greatly before and after the implementation of zero price policy.χ2=24.586,χ2/df=1.446,RMSEA=0.019,GFI=0.995,AGFI=0.989,CFI=0.988,NFI=0.963manifested good model fitting.Factor loading of drug cost increased greatly,indicating the burden of inpatients was reduced after the implementation of zero price policy.Factor loading of inspection fees and treatment fees increased significantly,the characterizationeffects of them to the burden of inpatients were enhanced.Factor loading of nursing fees was the lowest,and it had theweakest effects on the burden of inpatients,of which the government should enhance the regulation.CONCLUSIONS:Established model has good reliability and validity.It can reflect the change of burden factor loading of inpatients before and after the implementation of zero price policy.